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| {{SI}} | | {{Anhedonia}} |
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| {{Infobox disease
| | '''For patient information, click [[Anhedonia (patient information)|here]]''' |
| | Name = Anhedonia
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| | MeshID = D059445
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| ==Overview== | | ==[[Anhedonia overview|Overview]]== |
| '''Anhedonia''' is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, music, sexual activities or social interactions. ({{IPAc-en|ˌ|æ|n|h|i|ˈ|d|oʊ|n|i|ə}} {{respell|AN|hee|DOH|nee-ə}}; [[Greek language|Greek]]: ἀν- ''an''-, "without" + ἡδονή ''hēdonē'', "pleasure"). While earlier definitions of anhedonia emphasized pleasurable experience, more recent models have highlighted the need to consider different aspects of enjoyable behavior, such as motivation or desire to engage in an activity ("motivational anhedonia"), as compared to the level of enjoyment of the activity itself ("consummatory anhedonia").<ref>Treadway MT, Zald DH (2011) Reconsidering anhedonia in depression: lessons from translational neuroscience. Neurosci Biobehav Rev 35:537-555.</ref>
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| Anhedonia can be a characteristic of [[mental disorder]] including [[mood disorder]], [[schizoaffective disorder]], [[schizoid personality disorder]] and [[schizophrenia]]. For example, people affected with schizophrenia often describe themselves as feeling emotionally empty.<ref>Hales R., Yudofsky S., Talbott J. 1999. Textbook of Psychiatry 3rd ed. Washington DC: The American Psychiatric Press.{{Page needed|date=August 2011}}</ref> Mood disturbances are commonly observed in many psychiatric disorders, oftern precipitated by stressful life events and physical illness.<ref>{{cite book |first1=Michael G. |last1=Gelder |first2=Richard |last2=Mayou |first3=John |last3=Geddes |first4=John |last4=Geddes |year=2005 |title=Psychiatry |edition=3rd |publisher=Oxford University Press |pages=2, 99 |isbn=978-0-19-852863-0}}</ref> While anhedonia can be a feature of such mood changes, they are not mutually inclusive.
| | ==[[Anhedonia historical perspective|Historical Perspective]]== |
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| According to William James the term was coined by Théodule-Armand Ribot. One can distinguish many kinds of pathological depression. Sometimes it is mere passive joylessness and dreariness, discouragement, dejection, lack of taste and zest and spring. Professor Ribot has proposed the name anhedonia to designate this condition.<ref>''Varieties of Religious Experience'' Lecture VI, The Sick Soul, William James 1902</ref></blockquote>
| | ==[[Anhedonia pathophysiology|Pathophysiology]]== |
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| ==Causes== | | ==[[Anhedonia causes|Causes]]== |
| Researchers theorize that anhedonia may result from the breakdown in the [[reward system|brain's reward system]], involving the [[neurotransmitter]] [[dopamine]]. Studies by Paul Keedwell, MD, then of [[King's College London|King's College]], found that the brains of participants who were [[Major depressive disorder|clinically depressed]] had to work harder to process rewarding experiences.<ref>John McManamy, [http://www.mcmanweb.com/no_pleasure.html "No Pleasure, No Reward – Plenty of Depression"], URL accessed 2009-02-17{{Self-published inline|date=August 2011}}</ref><ref>{{cite journal |pages=446–55 |doi=10.1192/apt.9.6.446 |title=Neural systems underlying affective disorders |year=2003 |last1=Surguladze |first1=S. |journal=Advances in Psychiatric Treatment |volume=9 |issue=6}}</ref> While earlier research believed dopamine to be primarily involved in the subjective experience of pleasure, the last 20 years has seen a conceptual shift, such that dopamine is now believed to underlie various aspects of reward anticipation, learning, and motivation.<ref>Berridge, K. C. (2007) The debate over dopamine's role in reward: the case for incentive salience. ''Psychopharmacology'' (Berl) 191:391-431.</ref><ref>Salamone, J. D., Correa, M., Farrar, A., Mingote, S. M. (2007) "Effort-related functions of nucleus accumbens dopamine and associated forebrain circuits". ''Psychopharmacology'' (Berl) 191:461-482</ref><ref>Schultz W (2007) Multiple dopamine functions at different time courses. Annu Rev Neurosci 30:259-288.</ref>
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| Anhedonia is also a relatively common [[side effect]] of antidopaminergic neuroleptics or [[antipsychotic]] drugs.
| | ==[[Anhedonia epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Significance in depression== | | ==[[Anhedonia risk factors|Risk factors]]== |
| As a clinical symptom in depression, anhedonia rates highly in making a diagnosis of this disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes a "lack of interest or pleasure", but these can be difficult to discern given that people tend to become less interested in things which do not give them pleasure. The DSM criterion of weight loss is probably related, and many individuals with this symptom describe a lack of enjoyment of food. People suffering from anhedonia in association with depression generally feel good in the morning and unhappy in the evenings and can portray any of the non-psychotic symptoms and signs of depression.<ref name="Tomb2007">{{cite book |first=David A. |last=Tomb |title=Psychiatry |url=http://books.google.com/books?id=lt0-i8xLINoC |accessdate=18 December 2010 |date=1 August 2007 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-7452-9 |page=44}}</ref>
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| ===Common Causes=== | | ==Diagnosis== |
| *[[Amphetamine]]
| | [[Anhedonia diagnostic criteria|Diagnostic Criteria]], [[Anhedonia history and symptoms|History and Symptoms]] |
| *[[Cocaine]]
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| *[[Methamphetamine]]
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| ===Causes in Alphabetical Order=== | | ==Treatment== |
| *[[Addiction]]
| | [[Anhedonia medical therapy|Medical Therapy]], [[Anhedonia primary prevention|Primary Prevention]], [[Anhedonia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]], [[Anhedonia future or investigational therapies|Future or Investigational Therapies]] |
| *[[Amphetamines]]
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| *[[Clinical depression]]
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| *[[Cocaine]]
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| *[[Disorganized schizophrenia]]
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| *[[Dysthymia]]
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| *[[Schizophrenia]]
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| ==Significance in depression==
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| As a clinical symptom in depression, anhedonia rates highly in making a diagnosis of this disorder. The DSM describes a "lack of interest or pleasure" but these can be hard to tease apart given that people become less interested in things which do not give them pleasure. The DSM criterion of weight loss is probably related to it and many depressed people with this symptom describe a lack of enjoyment from food.
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| '''Bold text'''
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| ==Sexual anhedonia==
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| Sexual anhedonia in males is also known as 'ejaculatory anhedonia'. This condition means that the person will [[ejaculate]] with no accompanying sense of pleasure.
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| The condition is most frequently found in males, but women can suffer from lack of pleasure when the body goes through the [[orgasm]] process as well.
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| Sexual anhedonia may be caused by:
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| * [[Hyperprolactinaemia]]
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| * Hypoactive sexual desire disorder (HSDD), also called [[inhibited sexual desire]]
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| * Low levels of the hormone [[testosterone]]
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| * Spinal cord injury
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| * [[Multiple sclerosis]]
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| * Use (or previous use) of [[SSRI]] antidepressants<ref>{{cite journal |doi=10.1111/j.1743-6109.2007.00630.x |title=Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors |year=2007 |last1=Csoka |first1=Antonei |last2=Bahrick |first2=Audrey |last3=Mehtonen |first3=Olli-Pekka |journal=Journal of Sexual Medicine |volume=5 |pages=227–233 |pmid=18173768 |issue=1}}</ref>
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| * Use (or previous use) of antidopaminergic neuroleptics (anti-psychotics)<ref>{{cite journal |pmid=10401732 |year=1999 |last1=Tupala |first1=E |last2=Haapalinna |first2=A |last3=Viitamaa |first3=T |last4=Männistö |first4=PT |last5=Saano |first5=V |title=Effects of repeated low dose administration and withdrawal of haloperidol on sexual behaviour of male rats |volume=84 |issue=6 |pages=292–5 |journal=Pharmacology & toxicology |doi=10.1111/j.1600-0773.1999.tb01497.x}}</ref><ref>{{cite journal |pmid=29337 |year=1978 |last1=Martin-Du Pan |first1=R |title=Neuroleptics and sexual dysfunction in man. Neuroendocrine aspects |volume=122 |issue=2 |pages=285–313 |journal=Schweizer Archiv fur Neurologie, Neurochirurgie und Psychiatrie = Archives suisses de neurologie, neurochirurgie et de psychiatrie}}</ref>
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| * Fatigue
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| * Physical illness
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| It is very uncommon that a neurological examination and blood tests can determine the cause of a specific case of sexual anhedonia.
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| Patients may be prescribed sustained-release [[bupropion]] to aid in treatment, which has been shown to relieve sexual dysfunction even in patients without depression.<ref>{{cite journal |pmid=3121861 |year=1987 |last1=Crenshaw |first1=Theresa L. |last2=Goldberg |first2=James P. |last3=Stern |first3=Warren C. |title=Pharmacologic modification of psychosexual dysfunction |volume=13 |issue=4 |pages=239–52 |doi=10.1080/00926238708403896 |journal=Journal of Sex & Marital Therapy}}</ref>
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| Sexual anhedonia may be caused by:
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| A urological examination and blood tests can determine the cause of a specific case of sexual anhedonia. If no physiological problems are found, one should seek treatment via psychotherapy with a certified sex therapist, or psychotherapist.
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| Patients may be prescribed sustained-release [[bupropion]] to aid in treatment, because bupropion has been shown to increase sexual desire and intensity of orgasm.
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| ==Social anhedonia==
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| ===Definition===
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| ''Social anhedonia'' is defined as a trait-like disinterest in social contact and is characterized by social withdrawal and decreased pleasure in social situations. This characteristic typically manifests as an indifference to other people.<ref name="Blanchard, J.J. 2000">Blanchard, J.J., Gangestad, S.W., Brown, S.A., & Horan, W.P. (2000). Hedonic capacity and schizotypy revisited: A taxometric analysis of social anhedonia. ‘’Journal of Abnormal Psychology, 109’’, 87–95.</ref> In contrast to [[Extroversion and introversion|introversion]], a nonpathological dimension of human personality, social anhedonia represents a deficit in the ability to experience [[pleasure]].<ref>Silvia, P.J., & Thomas, R.K. (in press). Aberrant asociality: How individual differences in social anhedonia illuminate the need to belong. ‘’Journal of Personality’’.</ref> Additionally, social anhedonia differs from [[social anxiety]] in that social anhedonia is predominantly typified by diminished positive affect, while social anxiety is distinguished by both decreased [[Affect theory|positive affect]] and exaggerated [[Affect theory|negative affect]].<ref name="Brown, L.H. 2008">Brown, L.H., Silvia, P.J., Myin-Germeys, I., Lewandowski, K.E., & Kwapil, T.R. (2008). The relationship of social anxiety and social anhedonia to psychometrically identified schizotypy. ‘’Journal of Social and Clinical Psychology, 27’’, 127-149.</ref> This trait is currently seen as a central characteristic to, as well as a predictor of, [[schizophrenia|schizophrenia-spectrum disorders]].<ref>Kwapil, T.R. (1998). Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders. ‘’Journal of Abnormal Psychology, 107’’, 558–565.</ref>
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| ===Signs/Symptoms===
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| * Decreased ability to experience interpersonal pleasure
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| * Social withdrawal/isolation
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| * Decreased need for social contact
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| * Lack of close friends and intimate relationships, and decreased quality of those relationships
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| * Poor social adjustment
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| * Decreased positive affect
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| * Flat affect
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| * [[Depression (mood)|Depressed mood]]
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| * State-related anxiety<ref>Mishlove, M., & Chapman, L. J. (1985). Social anhedonia in the prediction of psychosis proneness. Journal of abnormal psychology, 94(3), 384–396.</ref><ref>Kwapil, T R. (1998). Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders. Journal of abnormal psychology, 107(4), 558–565.</ref>
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| Social anhedonia is trait-related, meaning it remains stable throughout life, independent of diagnosis, treatment, or symptom remission.<ref>Blanchard, J. J., Mueser, K. T., & Bellack, A. S. (1998). Anhedonia, positive and negative affect, and social functioning in schizophrenia. Schizophrenia bulletin, 24(3), 413–424.</ref>
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| ===Background and early clinical observation===
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| The term ''anhedonia'' is derived from the Greek ‘’an-’’, "without" + ‘’hēdonē’’, "pleasure".<ref>Di Giannantonio, M., & Martinotti, G. (2012). Anhedonia and major depression: The role of agomelatine. ""European neuropsychopharmacology, 22"", Supplement 3, S505–S510.</ref> Interest in the nature of pleasure and its absence dates back to ancient Greek philosophers such as [[Epicurus]].<ref>Der-Avakian, A., & Markou, A. (2011). The neurobiology of anhedonia and other reward-related deficits. ‘’Trends in Neurosciences, 35’’’’ 68–77.</ref> The symptoms of anhedonia were introduced to the realm of psychopathology in 1809 by [[John Haslam]], who characterized a patient suffering from schizophrenia as indifferent to “those objects and pursuits which formerly proved sources of delight and instruction.”.<ref>Noll, R. (1959). ‘’The encyclopedia of schizophrenia and other psychotic disorders’’ (p. xii). New York : Facts on File.</ref> The concept was formally coined by [[Théodule-Armand Ribot]] and later used by psychiatrists [[Paul Eugen Bleuler]] and [[Emil Kraepelin]] to describe a core symptom of schizophrenia.<ref name="DerAvakian">Der-Avakian, A., & Markou, A. (2011). The neurobiology of anhedonia and other reward-related deficits. ‘’Trends in Neurosciences, 35’’, 68–77.</ref> Theorists Sándor Radó and [[Paul Meehl]] posited that anhedonia represents an underlying genetic vulnerability to schizophrenia-spectrum disorders.<ref>Horan, W.P., Kring, A.M., & Blanchard, J.J. (2006). Anhedonia in Schizophrenia: A Review of Assessment Strategies. ‘’Schizophrenia Bulletin, 32’’, 259–273.</ref> In particular, Rado postulated that schizotypes, or individuals with the schizophrenic phenotype, have two key genetic deficits, one related to the ability to feel pleasure (anhedonia) and one related to [[proprioception]]. In 1962 Meehl furthered Rado’s theory through the introduction of the concept of schizotaxia, a genetically-driven neural integrative defect thought to give rise to the personality type of [[schizotypy]].<ref>Meehl, P.E. (1989). Schizotaxia revisited. ‘’Archives in General Psychiatry, 46’’, 935-944.</ref> Loren and Jean Chapman further distinguished between two types of anhedonia: physical anhedonia, or a deficit in the ability to experience physical pleasure, and social, or a deficit in the ability to experience interpersonal pleasure.<ref>Kontaxakis, V., Kollias, C., Margariti, M., Stamouli, S., Petridou, E., & Christodoulou, G.N. (2006). Physical anhedonia in the acute phase of schizophrenia. ‘’Annals of General Psychiatry, 5’’, 1-6.</ref>
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| Recent research suggests that social anhedonia may represent a [[prodrome]] of psychotic disorders.<ref name="Blanchard, J.J. 2000"/><ref>Mann, M.C. (2006). ‘’Verbal and Nonverbal Expressions as Indicators of Social and Emotional Functioning among Social Anhedonics’’. Master’s Thesis. University of Maryland, College Park. College Park, MD.</ref><ref>Silvia, P.J., & Thomas, R.K. (2011). Aberrant asociality: How individual differences in social anhedonia illuminate the need to belong. ‘’Journal of Personality, 79’’.</ref> First-degree relatives of individuals with schizophrenia show elevated levels of social anhedonia,<ref>Cohen, A.S., Emmerson, L.C., Mann, M.C., Forbes, C.B., & Blanchard, J.J. (2010). Schizotypal, schizoid and paranoid characteristics in the biological parents of social anhedonics. ‘’Psychiatry Research, 178’’, 79-83.</ref> higher baseline scores of social anhedonia are associated with later development of schizophrenia.<ref>Gooding, D.C., Tallent, K.A., & Matts, C.W. (2005). Clinical status of at-risk individuals five years later: Further validation of the psychometric high-risk strategy. ‘’Journal of Abnormal Psychology, 114’’, 170-175.</ref> These findings provide support for the conjecture that it represents a genetic risk marker for schizophrenia-spectrum disorders.
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| Additionally, elevated levels of social anhedonia in patients with schizophrenia have been linked to poorer social functioning.<ref>Blanchard, J.J., Bellack, A.S., & Mueser, K.T. (1994). Affective and social-behavioral correlates of physical and social anhedonia in schizophrenia. ‘’Journal of Abnormal Psychology, 103’’, 719-728.</ref><ref>Blanchard, J.J., Mueser, K.T., & Bellack, A.S. (i1998). Anhedonia, positive and negative affect, and social functioning in schizophrenia. ‘’Schizophrenia Bulletin, 24’’, 413–424.</ref> Socially anhedonic individuals perform worse on a number of neuropsychological tests than non-anhedonic participants,<ref>Laurent, A., Biloa-Tang, M., Bougerol, T., Duly, D., Anchisi, A.M., Bosson, J.L., Pellat, J., d’Amato, T., & Dalery, J. (2000). Executive/ attentional performance and measures of schizotypy in patients with schizophrenia and in their nonpsychotic first-degree relatives. ‘’Schizophrenia Research, 46’’, 269–283.</ref><ref>Cohen, A., Leung, W., Saperstein, A., & Blanchard, J. (2006). Neuropsychological functioning and social anhedonia: Results from a community high-risk study. ‘’Schizophrenia Research, 85’’, 132−141.</ref> and show similar physiological abnormalities seen in patients with schizophrenia.<ref>Cohen, A.S., Leung, W.W., Saperstein, A.M., & Blanchard, J.J. (2006). Neuropsychological functioning and social anhedonia: results from a community high-risk study. ‘’Schizophrenia Research, 85’’, 132-141.</ref>
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| ===Comorbidity===
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| Anhedonia is present in several forms of psychopathology.<ref>American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (2000). Washington, DC, American Psychiatric Association.</ref> However, social anhedonia is not a necessary symptom criterion of any disorder. Social anhedonia manifests similarly in a variety of different mental illness, but for differing reasons. Most frequently, social anhedonia is associated with schizophrenia and schizophrenia spectrum disorders (including schizotypal personality disorder, paranoid personality disorder, and antisocial personality disorder). Social anhedonia has also been implicated in other psychological disorders:
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| ====Depression====
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| Social anhedonia is observed in both depression and schizophrenia. However, social anhedonia is state related to the depressive episode and the other is trait related to the personality construct associated with schizophrenia. These individuals both tend to score highly on self-report measures of social anhedonia. Blanchard, Horan, and Brown (2001) demonstrated that, although both the depression and the schizophrenia patient groups can look very similar in terms of social anhedonia cross sectionally, over time as individuals with depression experience symptom remission, they show fewer signs of social anhedonia, while individuals with schizophrenia do not.<ref>Blanchard, J.J., Horan, W.P., & Brown, S.A. (2001). Diagnostic differences in social anhedonia: A longitudinal study of schizophrenia and major depressive disorder. ''Journal of Abnormal Psychology'', 110, 363-371.</ref> Blanchard and colleagues (2011) found individuals with social anhedonia also had elevated rates of lifetime mood disorders including depression and dysthymia compared to controls.<ref>Blanchard, J.J., Collins, L.M., Aghevli, M., Leung, W.W. & Cohen, A.S. (2011). Social anhedonia and schizotypy in a community sample: the Maryland longitudinal study of schizotypy. ''Schizophrenia Bulletin'', 37, 587-602.</ref>
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| ====Social Anxiety====
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| As mentioned above, social anxiety and social anhedonia differ in important ways.<ref name="Brown, L.H. 2008"/> However, social anhedonia and social anxiety are also often comorbid with each other. People with social anhedonia may display increased social anxiety and be at increased risk for social phobias and generalized anxiety disorder.<ref>Rey, G., Jouvent, R., & Dubal, S. (2009). Schizotypy, depression, and anxiety in physical and social anhedonia. Journal of clinical psychology, 65(7), 695–708. {{DOI|10.1002/jclp.20577}}</ref> It has yet to be determined what the exact relationship between social anhedonia and social anxiety is, and if one potentiates the other.<ref>Horan, W. P., Kring, A. M., & Blanchard, J. J. (2006). Anhedonia in schizophrenia: a review of assessment strategies. Schizophrenia bulletin, 32(2), 259–273. {{DOI|10.1093/schbul/sbj009}}</ref> Individuals with social anhedonia may display increased stress reactivity, meaning that they feel more overwhelmed or helpless in response to a stressful event compared to control subjects who experience the same type of stressor. This dysfunctional stress reactivity may correlate with hedonic capacity, providing a potential explanation for the increased anxiety symptoms experienced in people with social anhedonia.<ref>Horan, W. P., Brown, S. A., & Blanchard, J. J. (2007). Social anhedonia and schizotypy: the contribution of individual differences in affective traits, stress, and coping. Psychiatry research, 149(1-3), 147–156. {{DOI|10.1016/j.psychres.2006.06.002}}</ref> In an attempt to separate out social anhedonia from social anxiety, the Revised Social Anhedonia Scale <ref>Eckblad, M.L., Chapman, L.J., Chapman, J.P., & Mishlove, M. (1982). The Revised Social Anhedonia Scale. Unpublished test</ref> didn’t include items that potentially targeted social anxiety.<ref>Kwapil, T R. (1998). Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders. Journal of abnormal psychology, 107(4), 558–565</ref> However, more research must be conducted on the underlying mechanisms through which social anhedonia overlaps and interacts with social anxiety. The efforts of the “social processes” RDoC initiative will be crucial in differentiating between these components of social behavior that may underlie mental illnesses such as schizophrenia.<ref>http://www.nimh.nih.gov/research-funding/rdoc/index.shtml</ref>
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| ===Primary relevance in schizophrenia & schizophrenia spectrum disorders===
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| Social anhedonia is a core characteristic of [[schizotypy]], which is defined as a continuum of personality traits that can range from normal to disordered and contributes to risk for [[psychosis]] and [[schizophrenia]].<ref>Meehl PE. Schizotaxia, schizotypy, schizophrenia. The American Psychologist 1962;17(12):827–838</ref> Social anhedonia is a dimension of both negative and positive schizotypy.<ref>Kwapil, Thomas R, Barrantes-Vidal, N., & Silvia, P. J. (2008). The dimensional structure of the Wisconsin Schizotypy Scales: factor identification and construct validity. Schizophrenia bulletin, 34(3), 444–457. {{DOI|10.1093/schbul/sbm098}}</ref> It involves social and interpersonal deficits, but is also associated with cognitive slippage and disorganized speech, both of which fall into the category of positive schizotypy.<ref name="Gooding, D C 2001">Gooding, D C, Tallent, K. A., & Hegyi, J. V. (2001). Cognitive slippage in schizotypic individuals. The Journal of nervous and mental disease, 189(11), 750–756</ref><ref>Kerns, J. G. (2006). Schizotypy facets, cognitive control, and emotion. Journal of abnormal psychology, 115(3), 418–427. {{DOI|10.1037/0021-843X.115.3.418}}</ref><ref>Collins, L. M., Blanchard, J. J., & Biondo, K. M. (2005). Behavioral signs of schizoidia and schizotypy in social anhedonics. Schizophrenia research, 78(2-3), 309–322. {{DOI|10.1016/j.schres.2005.04.021}}</ref> Not all people with schizophrenia display social anhedonia <ref name="Chapman, L. J. 1976">Chapman, L. J., Chapman, J. P., & Raulin, M. L. (1976). Scales for physical and social anhedonia. Journal of abnormal psychology, 85(4), 374–382</ref> and likewise, people who have social anhedonia may never be diagnosed with a schizophrenia-spectrum disorder if they do not have the positive and cognitive symptoms that are most frequently associated with most schizophrenia-spectrum disorders.<ref name="Chapman, L. J. 1994">Chapman, L. J., Chapman, J. P., Kwapil, T. R., Eckblad, M., & Zinser, M. C. (1994). Putatively psychosis-prone subjects 10 years later. Journal of abnormal psychology, 103(2), 171–183</ref>
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| Social anhedonia may be a valid predictor of future schizophrenia-spectrum disorders;<ref name="Chapman, L. J. 1994"/><ref>Rey, G., Jouvent, R., & Dubal, S. (2009). Schizotypy, depression, and anxiety in physical and social anhedonia. Journal of clinical psychology, 65(7), 695–708</ref> young adults with social anhedonia perform in a similar direction to schizophrenia patients in tests of cognition and social behavior tests, showing potential predictive validity.<ref name="Gooding, D C 2001"/><ref>Gooding, Diane C, Tallent, K. A., & Matts, C. W. (2005). Clinical status of at-risk individuals 5 years later: further validation of the psychometric high-risk strategy. Journal of abnormal psychology, 114(1), 170–175</ref> Social anhedonia usually manifests in adolescence, possibly because of a combination of the occurrence of critical neuronal development and synaptic pruning of brain regions important for social behavior and environmental changes, when adolescents are in the process of becoming individuals and gaining more independence.
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| ===Treatment===
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| There is no validated treatment for social anhedonia.<ref>Horan, W. P., Kring, A. M., & Blanchard, J. J. (2006). Anhedonia in schizophrenia: a review of assessment strategies. Schizophrenia bulletin, 32(2), 259–273</ref> Future research should focus on genetic and environmental risk factors to home in on specific brain regions and neurotransmitters that may be implicated in social anhedonia etiology and could be targeted with specialized pharmacological or behavioral treatments. Social support may also play a valuable role in the treatment of social anhedonia Blanchard et al. (2011) <ref>Blanchard, J.J., Collins, L.M., Aghevli, M., Leung, W.W. & Cohen, A.S. (2011). Social anhedonia and schizotypy in a community sample: the Maryland longitudinal study of schizotypy. ''Schizophrenia Bulletin'', 37, 587-602</ref> found that a greater number of social supports as well as a greater perceived social support network were related to fewer schizophrenia-spectrum symptoms and to better general functioning within the social anhedonia group. Therefore, future studies should also examine ways to increase social support among individuals with social anhedonia in order to alleviate some of the symptoms.
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| ===Sex differences===
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| In the general population, males score higher than females on measures of social anhedonia.<ref>Fonseca-Pedrero, E., Lemos-Giráldez, S., Muñiz, J., García-Cueto, E., & Campillo-Alvarez, A. (2008). Schizotypy in adolescence: the role of gender and age. The Journal of nervous and mental disease, 196(2), 161–165</ref> This sex difference is stable throughout time (from adolescence into adulthood) and is also seen in people with schizophrenia-spectrum disorders. These results may reflect a more broad pattern of interpersonal and social deficits seen in schizophrenia-spectrum disorders.<ref>Miettunen, J., & Jääskeläinen, E. (2010). Sex differences in Wisconsin Schizotypy Scales--a meta-analysis. Schizophrenia bulletin, 36(2), 347–358</ref> On average, males with schizophrenia are diagnosed at a younger age, have more severe symptoms, worse treatment prognosis, and a decrease in overall quality of life compared to females with the disorder.<ref>Leung A, Chue P. Sex differences in schizophrenia, a review of the literature. ''Acta Psychiatr Scand''. 2000;101:3–38</ref> These results, coupled with the sex difference seen in social anhedonia, outline the necessity for research on genetic and hormonal characteristics that differ between males and females, and that may increase risk or resilience for mental illnesses such as schizophrenia.<ref>Jessen, H. M., & Auger, A. P. (2011). Sex differences in epigenetic mechanisms may underlie risk and resilience for mental health disorders. Epigenetics: official journal of the DNA Methylation Society, 6(7), 857–861</ref>
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| ===Assessing Social Anhedonia===
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| There are several self-report psychometric measures of [[schizotypy]] which each contain subscales related to social anhedonia:
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| * Revised Social Anhedonia Scale—Chapman Psychosis Proneness Scales <ref>Eckblad, M.L., Chapman, L.J., Chapman, J.P., & Mishlove, M. (1982). The Revised Social Anhedonia Scale. Unpublished test.</ref><ref>Chapman, L.J., Chapman, J.P., & Raulin, M.L. (1976). Scales for physical and social anhedonia. ''Journal of Abnormal Psychology'', 85, 374-382.</ref>
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| * No Close Friends Subscale—Schizotypyal Personality Questionnaire <ref>Raine, A. (l991). The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. ''Schizophrenia Bulletin'', 17, 555-564.</ref>
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| * Introverted Anhedonia Subscale—Oxford Liverpool Inventory of Feelings & Experiences <ref>Mason, O., Claridge, G., & Jackson, M. (l995). New scales for the assessment of schizotypy. Personality and Individual Differences, 18, 7-13.</ref>
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| ===Genetic components===
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| L.J. and J.P. Chapman <ref name="Chapman, L. J. 1976"/> were the first to discuss the possibility that social anhedonia may stem from a genetic vulnerability. The Disrupted in Schizophrenia 1 (DISC1) gene has been consistently associated with risk for, and etiology of, schizophrenia-spectrum disorders and other mental illnesses.<ref>Brandon, Nicholas J, & Sawa, A. (2011). Linking neurodevelopmental and synaptic theories of mental illness through DISC1. Nature reviews. ''Neuroscience'', 12(12), 707–722</ref> More recently, [[DISC1]] has been associated with social anhedonia within the general population.<ref>Tomppo, L., Hennah, W., Miettunen, J., Järvelin, M.-R., Veijola, J., Ripatti, S., … Ekelund, J. (2009). Association of variants in DISC1 with psychosis-related traits in a large population cohort. Archives of general psychiatry, 66(2), 134–141</ref> Tomppo (2009) identified a specific DISC1 [[allele]] that is associated with an increase in characteristics of social anhedonia. They also identified a DISC1 allele associated with decreased characteristics of social anhedonia, that was found to be preferentially expressed in women. More research needs to be conducted, but social anhedonia may be an important intermediate phenotype ([[endophenotype]]) between genes associated with risk for schizophrenia and phenotype of the disorder. Continued study of social anhedonia and its genetic components will help researchers and clinicians learn more about the etiology of schizophrenia-spectrum disorders.
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| ===Neurobiological correlates===
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| Researchers studying the neurobiology of social anhedonia posit that this trait may be linked to dysfunction of reward-related systems in the brain. This circuitry is critical for the sensation of pleasure, the computation of reward benefits and costs, determination of the effort required to obtain a pleasant stimulus, deciding to obtain that stimulus, and increasing motivation to obtain the stimulus. In particular, the ventral striatum and areas of the [[prefrontal cortex]] (PFC), including the [[orbitofrontal cortex]] (OFC) and dorsolateral (dl) PFC, are critically involved in the experience of pleasure and the [[hedonic|Hedonism]] perception of rewards. With regards to neurotransmitter systems, [[endogenous opioid|opioid]], [[GABA|gamma-Aminobutyric acid]] and endocannabinoid systems in the [[nucleus accumbens]], [[ventral pallidum]], and OFC mediate the hedonic perception of rewards.<ref name="DerAvakian" /> Activity in the PFC and ventral striatum have been found to be decreased in anhedonic individuals with [[Major Depressive Disorder]] (MDD) and [[schizophrenia]]. However, schizophrenia may be less associated with decreased hedonic capacity and more with deficient reward appraisal.<ref>Wolf, D.H. (2006). Anhedonia in schizophrenia. ‘’Current Psychiatry Reports, 8’’, 322–328.</ref><ref>Gold, J.M., Waltz, J.A., Prentice, K.J., Morris, S.E., & Heerey, E.A. (2008). Reward processing in schizophrenia: a deficit in the representation of value. ‘’Schizophrenia Bulletin, 34’’, 835–847.</ref> Abnormal functioning of the anterior insula and the parietal cortex is also implicated in anhedonia. Dowd & Barch conducted an [[fMRI|Functional magnetic resonance imaging]] study in which schizophrenia-spectrum disorder patients and control participants made [[Valence (psychology)|valence]] and [[arousal]] ratings of their own responses to emotional stimuli. They found that higher levels of anhedonia were associated with diminished arousal, but not valence, ratings. Furthermore, they found that, in controls, greater levels of social anhedonia were related to decreased bilateral caudate activation in response to positive relative to negative stimuli. The authors posit that the striatum in anhedonic individuals might be dysfunctional such that it fails to tag the saliency of positive events. Consequently, these individuals may experience blunted emotion.<ref>Dowd, E.C., & Barch, D.M. (2010). Anhedonia and emotional experience in schizophrenia: neural and behavioral indicators. ‘’Biological Psychiatry, 67’’, 902–911.</ref>
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| Research further implicates that abnormalities in the circuitry underlying social cognition are also critically involved in the generation of anhedonic symptoms. Individuals high in social anhedonia show less activation in the anterior portion of the rostral medial prefrontal cortex (arMFC), right [[superior temporal gyrus]], and left [[somatosensory cortex]] during an emotion discrimination task; these regions are responsible for processing facial emotions. Moreover, the arMFC is highly relevant for social cognition, and the mPFC and somatosensory cortex are involved in theory of mind and mentalizing. Thus, social anhedonia appears to be related to dysfunction of neural systems involved in self/other representation and social perception.<ref>Germine, L., Garrido, L., Bruce, L., & Hooker, C. (2011). Social anhedonia is associated with neural abnormalities during face emotion processing. ‘’Neuroimage, 58’’, 935–945.</ref>
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| ==See also==
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| * [[Dysthymia]]
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| * [[Clinical depression]]
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| * [[Schizophrenia]]
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| ==Related Chapters== | | ==Related Chapters== |
| {{wiktionarypar|anhedonia}}
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| *[[Dysthymia]]
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| *[[Clinical depression]]
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| ==References==
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